Venous thromboembolism prophylaxis in obstetric patients after orthopedic injury: a systematic review

Background: To determine the risk of venous thromboembolism (VTE) and the clinical practice pattern for VTE prophylaxis after orthopedic fracture in pregnant and postpartum patients. This review was registered in PROSPERO (ID CRD42024499753). Methods: Literature searches of PubMed, Embase, Web of Science, and Clinicaltrials.gov were performed using key words relating to orthopedic fracture in pregnancy and VTE prophylaxis. Of 640 studies screened, 17 articles were eligible for inclusion. The primary outcome was whether VTE prophylaxis was administered and the medication, dose, and duration. Secondary outcomes included clinical characteristics of the pregnancy and fracture and the occurrence of complications including VTE. Data were analyzed by descriptive statistics and narrative synthesis, as the lack of controlled studies precluded meta-analysis. Results: The 17 eligible studies were all case reports or small case series. 26 cases were reported in which a fracture occurred during the prenatal period. Of the 26 patients, 23 received pharmacologic VTE prophylaxis. The majority received low molecular weight heparin (LMWH) or unfractionated heparin (UFH). Duration of prophylaxis ranged from 6 days to 20 weeks (the remainder of the pregnancy). Only one patient in the eligible reports had a VTE event; this patient had not received VTE prophylaxis. No complications of VTE prophylaxis were reported. Conclusion: Pharmacologic VTE prophylaxis is typically recommended in the general population after major orthopedic surgery and major traumatic injuries. Pregnant patients may be at additionally elevated risk of VTE after orthopedic injury compared to non-pregnant patients. The degree of benefit of VTE prophylaxis and the appropriate duration of therapy is not known due to lack of controlled studies in this population.